ADAPTIX¿ INTERBODY SYSTEM WITH TITAN NANOLOCK¿ SURFACE TECHNOLOGY
Report
- Report Number
- 3006340236-2022-00009
- Event Type
- Injury
- Date Received
- May 27, 2022
- Date of Event
- May 5, 2022
- Report Date
- February 9, 2023
- Manufacturer
- TITAN SPINE, INC.
- Product Code
- MAX
- UDI-DI
- 00763000203023
- PMA / PMN Number
- K201267
- Adverse Event
- Yes
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- AZ, US
- Reporter Occupation
- PHYSICIAN
- Health Professional
- Yes
Narratives
IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.
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¿DEFECTS¿ OR HAS ¿MALFUNCTIONED¿. THESE WORDS ARE INCLUDED IN THE FDA 3500A FORM AND ARE FIXED ITEMS FOR SELECTION CREATED BY THE FDA TO CATEGORIZE THE TYPE OF EVENT SOLELY FOR THE PURPOSE OF REGULATORY REPORTING. MEDTRONIC OBJECTS TO THE USE OF THESE WORDS AND OTHERS LIKE THEM BECAUSE OF THE LACK OF DEFINITION AND THE CONNOTATIONS IMPLIED BY THESE TERMS. THIS STATEMENT SHOULD BE INCLUDED WITH ANY INFORMATION OR REPORT DISCLOSED TO THE PUBLIC UNDER THE FREEDOM OF INFORMATION ACT. ANY REQUIRED FIELDS THAT ARE UNPOPULATED ARE BLANK BECAUSE THE INFORMATION IS CURRENTLY UNKNOWN OR UNAVAILABLE. A GOOD FAITH EFFORT WILL BE MADE TO OBTAIN THE APPLICABLE INFORMATION RELEVANT TO THE REPORT. IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.
MEDTRONIC IS SUBMITTING THIS REPORT TO COMPLY WITH FDA REPORTING REGULATIONS UNDER 21 CFR PARTS 4 AND 803. THIS REPORT IS BASED UPON INFORMATION OBTAINED BY MEDTRONIC, WHICH THE COMPANY MAY NOT HAVE BEEN ABLE TO FULLY INVESTIGATE OR VERIFY PRIOR TO THE DATE THE REPORT WAS REQUIRED BY THE FDA. MEDTRONIC HAS MADE REASONABLE EFFORTS TO OBTAIN MORE COMPLETE INFORMATION AND HAS PROVIDED AS MUCH RELEVANT INFORMATION AS IS AVAILABLE TO THE COMPANY AS OF THE SUBMISSION DATE OF THIS REPORT. THIS REPORT DOES NOT CONSTITUTE AN ADMISSION OR A CONCLUSION BY FDA, MEDTRONIC, OR ITS EMPLOYEES THAT THE DEVICE, MEDTRONIC, OR ITS EMPLOYEE CAUSED OR CONTRIBUTED TO THE EVENT DESCRIBED IN THE REPORT. IN PARTICULAR, THIS REPORT DOES NOT CONSTITUTE AN ADMISSION BY ANYONE THAT THE PRODUCT DESCRIBED IN THIS REPORT HAS ANY ¿DEFECTS¿ OR HAS ¿MALFUNCTIONED¿. THESE WORDS ARE INCLUDED IN THE FDA 3500A FORM AND ARE FIXED ITEMS FOR SELECTION CREATED BY THE FDA TO CATEGORIZE THE TYPE OF EVENT SOLELY FOR THE PURPOSE OF REGULATORY REPORTING. MEDTRONIC OBJECTS TO THE USE OF THESE WORDS AND OTHERS LIKE THEM BECAUSE OF THE LACK OF DEFINITION AND THE CONNOTATIONS IMPLIED BY THESE TERMS. THIS STATEMENT SHOULD BE INCLUDED WITH ANY INFORMATION OR REPORT DISCLOSED TO THE PUBLIC UNDER THE FREEDOM OF INFORMATION ACT. ANY REQUIRED FIELDS THAT ARE UNPOPULATED ARE BLANK BECAUSE THE INFORMATION IS CURRENTLY UNKNOWN OR UNAVAILABLE. A GOOD FAITH EFFORT WILL BE MADE TO OBTAIN THE APPLICABLE INFORMATION RELEVANT TO THE REPORT. IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.
H3. PRODUCT ANALYSIS PRODUCT ID : 84332812. LOT NO. : TM0128915. ANALYSIS FOUND THAT THE WITNESS MARKS CAN BE SEEN ON THE SPACER INDICATING THERE WAS SOME INTERFERENCE FIT. THERE IS NO NOTABLE DAMAGE OR DEFECT VISIBLE ON THE SPACER. DIMENSIONAL INSPECTION OF THE PART DOES NOT INDICATE THAT THE SPACER IS UNDERSIZE. IT DOES NOT APPEAR THE IS AN ISSUE WITH THE SPACE THAT WOULD HAVE CAUSED THE MIGRATION. MEDTRONIC IS SUBMITTING THIS REPORT TO COMPLY WITH FDA REPORTING REGULATIONS UNDER 21 CFR PARTS 4 AND 803. THIS REPORT IS BASED UPON INFORMATION OBTAINED BY MEDTRONIC, WHICH THE COMPANY MAY NOT HAVE BEEN ABLE TO FULLY INVESTIGATE OR VERIFY PRIOR TO THE DATE THE REPORT WAS REQUIRED BY THE FDA. MEDTRONIC HAS MADE REASONABLE EFFORTS TO OBTAIN MORE COMPLETE INFORMATION AND HAS PROVIDED AS MUCH RELEVANT INFORMATION AS IS AVAILABLE TO THE COMPANY AS OF THE SUBMISSION DATE OF THIS REPORT. THIS REPORT DOES NOT CONSTITUTE AN ADMISSION OR A CONCLUSION BY FDA, MEDTRONIC, OR ITS EMPLOYEES THAT THE DEVICE, MEDTRONIC, OR ITS EMPLOYEE CAUSED OR CONTRIBUTED TO THE EVENT DESCRIBED IN THE REPORT. IN PARTICULAR, THIS REPORT DOES NOT CONSTITUTE AN ADMISSION BY ANYONE THAT THE PRODUCT DESCRIBED IN THIS REPORT HAS ANY ¿DEFECTS¿ OR HAS ¿MALFUNCTIONED¿. THESE WORDS ARE INCLUDED IN THE FDA 3500A FORM AND ARE FIXED ITEMS FOR SELECTION CREATED BY THE FDA TO CATEGORIZE THE TYPE OF EVENT SOLELY FOR THE PURPOSE OF REGULATORY REPORTING. MEDTRONIC OBJECTS TO THE USE OF THESE WORDS AND OTHERS LIKE THEM BECAUSE OF THE LACK OF DEFINITION AND THE CONNOTATIONS IMPLIED BY THESE TERMS. THIS STATEMENT SHOULD BE INCLUDED WITH ANY INFORMATION OR REPORT DISCLOSED TO THE PUBLIC UNDER THE FREEDOM OF INFORMATION ACT. ANY REQUIRED FIELDS THAT ARE UNPOPULATED ARE BLANK BECAUSE THE INFORMATION IS CURRENTLY UNKNOWN OR UNAVAILABLE. A GOOD FAITH EFFORT WILL BE MADE TO OBTAIN THE APPLICABLE INFORMATION RELEVANT TO THE REPORT. IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.
INFORMATION WAS RECEIVED FROM A HEALTHCARE PROVIDER VIA A MANUFACTURER REPRESENTATIVE REGARDING A PATIENT WITH ALIF THERAPY. IT WAS REPORTED THAT THE CAGE WAS PLACED AS PART OF MIS TLIF. CAGE WAS IMPLANTED SUCCESSFULLY. POST INITIAL SURGERY CAGE MIGRATED & SPIT POSTERIORLY AND IT HAD TO BE REMOVED. AN ALIF WAS PERFORMED TO STABILIZE THE PATIENT'S SPINE. THE PATIENT HAD LEG PAIN FOLLOWING THE INITIAL SURGERY DUE TO MIGRATED CAGE. THERE WERE NO SYMPTOMS REPORTED. THERE WERE NO FURTHER COMPLICATIONS REPORTED REGARDING THE EVENT.
PROBLEM NAME: ALLERGIC RHINITIS LIFE CYCLE STATUS: CANCELED CONFIRMATION: CONFIRMED; COURSE: PERSISTENCE:: PROGNOSIS: ONSET DATE: PROBLEM NAME: AMBULATES WITH CANE LIFE CYCLE STATUS: ACTIVE LAST UPDATED: 3/17/2022 CONFIRMATION: CONFIRMED: COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET DATE: PROBLEM NAME: ANESTHESIA LIFE CYCLE STATUS: ACTIVE LAST UPDATED: (B)(6) 2022 CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET DATE: COMMENTS: (B)(6) 2022 PHONE SCREENED FOR LUMBAR LAMI AND FUSION SCHEDULED (B)(6) 2022. PT REPORTS HX OF POST OP NAUSEA AND SEVERE CONSTIPATION. AMB WITH A CANE 2/2 BACK PAIN AND UNSTEADY GAIT. PT WAS EVALUATED BY OUTSIDE CARDS (B)(6) 2020 FOR HIP ARTHROPLASTY AND AT THAT TIME "LOW RISK". STATES NO CHANGES IN HER BASELINE (OTHER THAN INCREASED BACK PAIN) SINCE THEN. PT TESTED FOR COVID (B)(6) 2022 AND HAS BEEN ASYMPTOMATIC, SO OK TO PROCEED WITH SURGERY 10 DAYS AFTER RESULT. PROBLEM NAME: BILATERAL CATARACTS LIFE CYCLE STATUS: CANCELED: LAST UPDATED: (B)(6) 2021 CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET DATE PROBLEM NAME: CHRONIC BILATERAL LOW BACK PAIN. LIFE CYCLE STATUS: ACTIVE LAST UPDATED: (B)(6) 2022 CONFIRMATION: CONFIRMED; COURSE: PERSISTENCE:; PROGNOSIS:: ONSET DATE: PROBLEM NAME: CHRONIC GERD LIFE CYCLE STATUS: CANCELED; CANCEL REASON: <(><<)>NOT ENTERED> LAST UPDATED: (B)(6)2021 CONFIRMATION: CONFIRMED; COURSE: PERSISTENCE: PROGNOSIS: ONSET DATE: PROBLEM NAME: COVID-19 LIFE CYCLE STATUS: ACTIVE LAST UPDATED: (B)(6)2022 CONFIRMATION: CONFIRMED; COURSE:; PERSISTENCE: PROGNOSIS:: ONSET DATE: COMMENTS:(B)(6)/2022; (B)(6) POSITIVE COVID TEST (B)(6)/2022. PT ASYMPTOMATIC PROBLEM NAME: DDD (DEGENERATIVE DISC DISEASE), LUMBAR LIFE CYCLE STATUS: ACTIVE LAST UPDATED: 6/14/2018 09:17 MST CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE:; PROGNOSIS:: ONSET DATE: PROBLEM NAME: DISCERNCM HX INFLUENZA DOSE LIFE CYCLE STATUS: RESOLVED LAST UPDATED: 8/24/2020 CONFIRMATION: CONFIRMED; COURSE:; PERSISTENCE:; PROGNOSIS:: ONSET DATE: COMMENTS: 8/24/2020: SYSTEM; INFLUENZA DOSE ADMINISTERED ON (B)(6) 2020 AT A (B)(6)FACILITY. PROBLEM NAME: DISCERNCM HX INFLUENZA DOSE LIFE CYCLE STATUS: RESOLVED LAST UPDATED: 10/25/2019 CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE: PROGNOSIS: ONSET DATE: PROBLEM NAME: DISCERNCM HX INFLUENZA DOSE COMMENTS: (B)(6)2019 SYSTEM; INFLUENZA DOSE ADMINISTERED ON (B)(6)2019 AT A BANNER FACILITY. LIFE CYCLE STATUS: RESOLVED LAST UPDATED: 9/12/2018 CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE:; PROGNOSIS:: ONSET DATE: COMMENTS: 9/12/2018; SYSTEM; INFLUENZA DOSE ADMINISTERED ON SEPTEMBER 12, 2018 AT A BANNER FACILITY. PROBLEM NAME: DISCERNCM HX INFLUENZA DOSE LIFE CYCLE STATUS: RESOLVED LAST UPDATED: 10/27/2017 CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET DATE: COMMENTS: 10/27/2017 SYSTEM; INFLUENZA DOSE ADMINISTERED ON OCTOBER 27, 2017 AT A BANNER FACILITY. PROBLEM NAME: DISCERNCM PNEUMOVAX DOSE1 LIFE CYCLE STATUS: RESOLVED LAST UPDATED: 8/28/2015 CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE:; PROGNOSIS: ONSET DATE: COMMENTS: 8/28/2015, SYSTEM; PNEUMOCOCCAL DOSE ADMINISTERED ON (B)(6) 2015 AT A BANNER FACILITY. PROBLEM NAME: ECZEMA LIFE CYCLE STATUS: CANCELED LAST UPDATED: 2/9/2021 CONFIRMATION: CONFIRMED; COURSE:; PERSISTENCE:: PROGNOSIS: ; ONSET DATE: PROBLEM NAME: ELEVATED HEMOGLOBIN A1C LIFE CYCLE STATUS: ACTIVE LAST UPDATED: 3/3/2017 CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET DATE: PROBLEM NAME: ESSENTIAL HYPERTENSION LIFE CYCLE STATUS: ACTIVE LAST UPDATED: 3/23/2022 CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET DATE: PROBLEM NAME: FOLLOW THROUGH ONCOLOGY LIFE CYCLE STATUS: ACTIVE PROGRAM LAST UPDATED: 10/20/2017 CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET DATE: PROBLEM NAME: HISTORY OF COLON POLYPS LIFE CYCLE STATUS: CANCELED; CANCEL REASON: <(><<)>NOT ENTERED> LAST UPDATED: 2/9/2021 CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET PROBLEM NAME: HISTORY OF INFLUENZA VACCINATION LIFE CYCLE STATUS: RESOLVED LAST UPDATED: 3/23/2022 CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET DATE: COMMENTS: (B)(6)2022: SYSTEM; INFLUENZA VACCINE PREVIOUSLY ADMINISTERED PRIOR TO ADMISSION FOR THIS FLU SEASON AS STATED BY PATIENT/PROXY ON (B)(6) 2022. PROBLEM NAME: HYPERCHOLESTEROLAEMIA LIFE CYCLE STATUS: RESOLVED LAST UPDATED: 4/17/2018 CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET DATE: PROBLEM NAME: HYPERLIPIDEMIA LIFE CYCLE STATUS: ACTIVE LAST UPDATED: 3/3/2017 CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET DATE: PROBLEM NAME: HYPERTENSION LIFE CYCLE STATUS: ACTIVE LAST UPDATED: 3/3/2017 CONFIRMATION: CONFIRMED: COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET DATE: PROBLEM NAME: LEFT HIP PAIN LIFE CYCLE STATUS: CANCELED LAST UPDATED: 1/29/2021 CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET DATE: PROBLEM NAME: LEFT LEG DVT LIFE CYCLE STATUS: RESOLVED; CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET DATE: LAST UPDATED: 1/18/2019 PROBLEM NAME: LOW BACK PAIN LIFE CYCLE STATUS: CANCELED; CANCEL REASON: <(><<)>NOT ENTERED> LAST UPDATED: 1/29/2021, CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE:: PROGNOSIS: ONSET DATE: PROBLEM NAME: LUMBARRADICULOPATHY LIFE CYCLE STATUS: ACTIVE LAST UPDATED: 3/17/2022 CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET DATE: PROBLEM NAME: LUMBAR SPINAL STENOSIS LIFE CYCLE STATUS: CANCELED; LAST UPDATED: 2/2/2021 CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE:: PROGNOSIS:; ONSET DATE: PROBLEM NAME: MEDICARE ANNUAL WELLNESS VISIT, SUBSEQUENT LIFE CYCLE STATUS: ACTIVE LAST UPDATED: 4/6/2022 CONFIRMATION: CONFIRMED; COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET DATE: PROBLEM NAME: NEUROGENIC CLAUDICATION LIFE CYCLE STATUS: ACTIVE LAST UPDATED: 3/17/2022; CONFIRMATION: CONFIRMED; COURSE:; PERSISTENCE:: PROGNOSIS:: ONSET DATE: PROBLEM NAME: OBESITY LIFE CYCLE STATUS: RESOLVED LAST UPDATED: 1/23/2020 CONFIRMATION:: COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET DATE: 7/24/2012 COMMENTS: CONVERTED NOTE: ONSET DATE (B)(6)2012 PROBLEM AUTOMATICALLY MAPPED TO SNOMED CODE "OBESITY FROM KBM CHRONIC CONDITIONS TABLE ON (B)(6)2014. PROBLEM NAME: OSTEOARTHRITIS LIFE CYCLE STATUS: CANCELED CANCEL REASON: NOT ENTERED LAST UPDATED: 2/2/2021 CODE: 177248011, CONFIRMATION: CONFIRMED COURSE PERSISTENCE: PROGNOSIS: ONSET DATE: PROBLEM NAME OSTEOPENIA LIFE CYCLE STATUS: CANCELED CANCEL REASON: NOT ENTERED LAST UPDATED: 2/2/2021 CODE: 45609401 CONFIRMATION: CONFIRMED, COURSE:: PERSISTENCE:: PROGNOSIS: ONSET DATE: PROBLEM NAME: OVERWEIGHT LIFE CYCLE STATUS: CANCELED CANCEL REASON: NOT ENTERED LAST UPDATED: 2/2/2021 CODE: 356060015, CONFIRMATION: CONFIRMED: COURSE: PERSISTENCE: PROGNOSIS:: ONSET DATE: PROBLEM NAME PLANTAR FASCIA LIFE CYCLE STATUS: CANCELED, CANCEL REASON: <(><<)>NOT ENTERED LAST UPDATED: 1292021 CODE: 107703014, CONFIRMATION: CONFIRMED, COURSE:: PERSISTENCE: PROGNOSIS:: ONSET DATE: PROBLEM NAME: PNEUMOCOCCAL VACCINATION GIVEN LIFE CYCLE STATUS: RE-SCHEDULED LAST UPDATED: (B)(6)2022 CODE: 264100018, CONFIRMATION: CONFIRMED, COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET DATE: COMMENTS: (B)(6)2022, SYSTEM: PNEUMOCOCCAL VACCINE WAS RECEIVED PRIOR TO ADMISSION AS STATED BY PATIENT/PROXY ON MARCH 23, 2022 PROBLEM NAME: POST-OPERATIVE NAUSEA AND VOMITING LIFE CYCLE STATUS: ACTIVE LAST UPDATED: 3/17/2022 CODE: 3596017: CONFIRMATION: CONFIRMED, COURSE:: PERSISTENCE: PROGNOSIS: ONSET DATE: PROBLEM NAME PREOP EXAMINATION LIFE CYCLE STATUS: ACTIVE LAST UPDATED: 2/9/2021 CODE: 44750 1012: CONFIRMATION: CONFIRMED, COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET DATE: PROBLEM NAME: RLQ ABDOMINAL PAIN LIFE CYCLE STATUS: CANCELED, CANCEL REASON: <(><<)>NOT ENTERED LAST UPDATED: 1/29/2021 CODE: 443197010. CONFIRMATION: CONFIRMED, COURSE:: PERSISTENCE:: PROGNOSIS:: ONSET DATE: PROBLEM NAME: RUQ PAIN LIFE CYCLE STATUS CANCELED, CANCEL REASON: NOT ENTERED LAST UPDATED: 1/29/2021 CODE: 443112015, CONFIRMATION: CONFIRMED, COURSE: PERSISTENCE PROGNOSIS: ONSET DATE: PROBLEM NAME: SACROILIACJOINT DYSFUNCTION LIFE CYCLE STATUS: ACTIVE LAST UPDATED: 2/9/2021 CODE 311272015, CONFIRMATION: CONFIRMED COURSE PERSISTENCE: PROGNOSIS: ONSET DATE: PROBLEM NAME: SCREENING FOR BREAST CANCER LIFE CYCLE STATUS: CANCELED CANCEL REASON: NOT ENTERED LAST UPDATED: 1/29/2021 CODE: 447501012, CONFIRMATION: CONFIRMED; COURSE:: PE RSISTENCE:: PROGNOSIS:: ONSET DATE: PROBLEM NAME: WAX INEAR LIFE CYCLE STATUS: RESOLVED; LAST UPDATED: 1/23/2020 CODE: 406643019, CONFIRMATION: CONFIRMED, COURSE:: PERSISTENCE: PROGNOSIS:: ONSET DATE: BRIEF HPI AND REASON FOR HOSPITALIZATION REFER TO H<(>&<)>P FOR DETAILS. PROCEDURES L4-5 TLIF, LAMINECTOMY AND POSTERIOR INSTRUMENTATION ((B)(6)2022) LAB RESULTS (LAST 24 HOURS) CHEMISTRY CHEM GENER HOSPITAL COURSE BY PROBLEM ORDERED: OT EVALUATION/TREATMENT, (B)(6)2022 8:17:00 MST, ACUTE CHANGE IN SELF CARE, YES. TO BEGIN DAY OF MECHANICS, NERVE ROOT STRETCH, AMBULATION ADL'S PT EVALUATION/TREATMENT, (B)(6) 2022 6:49:00 MST, ACUTE CHANGE IN BALANCE. YES SPINE LUMBOSACRAL 2 VIEW, (B)(6) 2022, ROUTINE, BED, S/P L4-5 TLIF, PSIF, 02 BNS, 03/2 (B)(6) 2022 16:31:00 MST CONDITION VITALS RESPIRATORY RATE-16 BR/ML (B)(6)2022 04:28 MEAN ARTERIAL PRESSURE- 81 MMHG 04:28 SYSTOLIC BLOOD PRESSURE-104 MMHG (B)(6)2022 04:28 DIASTOLIC BLOOD PRESSURE-69 MMHG (B)(6)2022 04:28 SP02-97% (B)(6)2022 04:28 OXYGEN THERAPY-ROOM AIR (B)(6)2022 04:28 TEMPERATURE ORAL-36.6 DEGC (B)(6)2022 04:28 TEMP F-97.9 DEG F (B)(6)2022 04:28 PERIPHERAL PULSE RATE-64 BPM (B)(6)2022 04:28 MAX TEMP 24HRS TEMPERATURE ORAL-37.1 DEGC (B)(6)2022 20:01 LUNGS: NON-LABORED RESPIRATION. HEART NORMAL RATE, WELL PERFUSED. SKIN: WARM, DRY, NO RASHES OR LESIONS EXCEPT AS COMMENTED BELOW SPINE: INSPECTION: SCARS/SKIN CHANGES: POSTSURGICAL DRESSING CLEAN, DRY NEUROLOGICAL EXAM: BULK: SYMMETRIC TONE: SYMMETRIC DISPOSITION: STABLE, DISCHARGE TO HOME WITH FAMILY. DIAGNOSIS: LUMBAR RADICULOPATHY ALLERGY INFORMATION POLLEN; GABAPENTIN START TAKING THE NEW MEDICATIONS: GABAPENTIN (GABAPENTIN 300 MG ORAL CAPSULE) METHOCARBAMOL (ROBAXIN-750 ORAL TABLET) OXYCODONE (OXYCODONE 10 MG ORAL TABLET) OXYCODONE (OXYCODONE 10 MG ORAL TABLET) DIAGNOSTIC RADIOLOGY REPORT: COMPARISON: RADIOGRAPHS OF LUMBAR SPINE DATED (B)(6)2022. FINDINGS: DECREASED BONE MINERALIZATION OF THE LUMBAR SPINE. THERE ARE 5 NONRIB-BEARING LUMBAR TYPE VERTEBRAL BODIES. POSTSURGICAL CHANGES RELATED TO TRANSFORAMINAL LUMBAR INTERBODY FUSION AND POSTERIOR SPINAL INTERBODY FUSION OF 14-5 WITH INTERVERTEBRAL BODY DISC SPACER. NO PERIHARDWARE LUCENCIES OR HARDWARE FRACTURES. ADDITIONAL POSTSURGICAL CHANGES RELATED TO 3 INTRA-ARTICULAR CAGE DEVICE OF THE RIGHT SACROILIAC JOINT, AND LEFT TOTAL HIP ARTHROPLASTY. NO ACUTE FRACTURE OR DISLOCATION. THE LEFT SACROILIAC JOINT AND SYMPHYSIS PUBIS ARE PATENT WITHOUT WIDENING. IMPRESSION: POSTSURGICAL CHANGES RELATED TO TLIF AND PSIF OF 14-15 WITHOUT ACUTE HARDWARE COMPLICATIONS. REPORT: STUDY: 2 INTRAOPERATIVE FLUOROSCOPIC IMAGES OF THE SPINE LUMBOSACRAL 2 VIEWS WERE OBTAINED. COMPARISON: LUMBAR SPINE CT FROM (B)(6)2022 FINDINGS/IMPRESSION: INTRAOPERATIVE IMAGES OF THE LUMBOSACRAL SPINE WERE OBTAINED FOR LOCALIZATION OF THE SURGICAL HARDWARE DURING POSTERIOR SEGMENT SPINAL FUSION. THE TOTAL FLUOROSCOPY TIME IS 38.3 SECONDS. CUMULATIVE DOSE: 19.72 MGY. THE RADIOLOGIST WAS NOT IN ATTENDANCE DURINGTHE PROCEDURE. THE IMAGES ARE NOT INTENDED FOR DIAGNOSTIC PURPOSES. PHYSICIAN PROGRESS NOTES SUBJECTIVE: PAIN WELL CONTROLLED OVERNIGHT. DIFFICULTY AMBULATING, REQUIRED ASSISTANCE TO RESTROOM DENIES FEVERS CHILLS, SWEAT, DYSPNEA. PHYSICAL EXAM GENERAL: ALERT <(>&<)> ORIENTED, NO ACUTE DISTRESS. ALLERGIES POLLEN (CONGESTION) GABAPENTIN (BLURRY VISION). MEDICAL DECISION MAKING: PATIENT MARTHA MENCH IS A 76-YEAR-OLD FEMALE PLEASANT PATIENT WITH NEUROGENIC CLAUDICATION AND LUMBAR RADICULOPATHY. S/P L4-5 TLIF, LAMINECTOMY AND POSTERIOR INSTRUMENTATION. DOING WELL IN HER POSTOPERATIVE COURSE, DOES APPRECIATE IMPROVEMENT IN RIGHT RADICULOPATHY PAIN. DIFFICULTY AMBULATING TO RESTROOM OVERNIGHT REQUIRING ASSISTANCE. (B)(6)2022: - PATIENT AMBULATING WITH FWW IN HALLS, MEDICATED FOR PAIN, DRESSING TO LOWER BACK CAME OFF AND WAS REPLACED, FWW DELIVERED TO ROOM, CALL LIGHT IN REACH. OPERATIVE-PROCEDURE REPORTS PRE-OPERATIVE DIAGNOSE LUMBAR RADICULOPATHY, NEUROGENIC CLAUDICATION SECONDARY TO SPINAL STENOSIS AT L4-L5 FAILED NONSURGICAL MANAGEMENT POST-OPERATIVE DIAGNOSIS : SAME INDICATIONS: THIS IS A PLEASANT 76-YEAR-OLD LADY WHO HAS HAD LUMBAR RADICULOPATHY. PROCEDURE TRANSFORAMINAL LUMBAR INTERBODY FUSION AT L4-L5 WITH LUMBAR LAMINECTOMY AT L4- L5 WITH INSTRUMENTATION USING AUTOGRAFT AND ALLOGRAFT AND INTERBODY DEVICE/ CODES: 1. ARTHRODESIS AT L4-L5-22633 2. POSTERIOR NONSEGMENTAL INSTRUMENTATION-22840 3 INSERTION OF INTERBODY BIOMECHANICAL DEVICE-22853 4. SPINAL COMPUTER NAVIGATION USING MAZOR-61783 5. LUMBAR LAMINECTOMY FACETECTOMY AND FORAMINOTOMY L4-L5-63047 6 MICROSCOPE-20939 7. AUTOGRAFT-20936 8. ALLOGRAFT-20930 9. BONE MARROW ASPIRATION BONE GRAFT SPINE SURGERY SEPARATE SKIN INCISION-20939 ANESTHESIA GENERAL POSITIONING: THE PATIENT WAS PLACED PRONE ON THE JACKSON 4 POST. THE PATIENT'S HEAD AND NECK WERE KEPT NEUTRAL. THERE WAS NO PRESSURE ON THE GLOBES OF THE EYES BILATERALLY. THE CHEST WAS APPROPRIATELY PADDED AND PROTECTED. THE ABDOMEN WAS ALLOWED TO HANG FREE. ALL SUPERFICIAL BONY PROMINENCES AND NERVES WERE PADDED AND PROTECTED. THE EXTERNAL GENITALIA WAS FREE OF ANY PRESSURE. THE KNEES WERE SUPPORTED, IT GENTLY FLEXED WITH THE KNEE FLEXED WITH SUPPORTS AND PILLOWS NEUROMONITORING THE PATIENT HAD SSEPS AND RUINING EMG WITH NO INTRAOPERATIVE SUSTAINED ABNORMALITIES. ANTIBIOTICS: THE PATIENT RECEIVED ANTIBIOTICS BASED ON THE ALLERGY PROFILE WITHIN AN HOUR OF THE PROCEDURE DEEP VEIN THROMBOSIS PROPHYLAXIS INTRAOPERATIVE PAS BOOTS. ESTIMATED BLOOD LOSS: APPROXIMATELY 100 OR LESS. COMPLICATIONS: NONE POSTOPERATIVE PLAN 1. THE PATIENT WILL BE ADMITTED TO THE FLOOR FOR IV ANTIBIOTIC FOR A TOTAL PERIOD OF 24 HOURS. 2. FOLEY WILL BE ATTEMPTED TO BE REMOVE POSTOP DAY 1 3. DVT PROPHYLAXIS WILL CONSIST OF EARLY MOBILIZATION WITH PAS BOOTS 4. DRAIN WILL BE REMOVED WHEN DRAINAGE IS APPROPRIATE. SUMMARY: THIS IS A PLEASANT 76 YEARS FEMALE WHO HAD A FULL HISTORY AND PHYSICAL AND FULL WRITTEN INFORMED CONSENT TAKEN FOR THE ABOVE-MENTIONED THE PATIENT WAS SEEN IN THE PREOPERATIVE ANESTHETIC AREA, SURGICAL SITE MARKED. THE PATIENT WAS SUBSEQUENTLY TAKEN TO THE OR ON A GUMEY WHERE A PREINDUCTION TIMEOUT WAS PERFORMED. THE PATIENT HAD APPROPRIATE LINES INSERTED AND THE PATIENT POSITIONED AS PREVIOUSLY MENTIONED. PREP AND DRAPE WAS DONE AS PER STANDARD STERILE PRECAUTIONS USING ALCOHOL AND CHLORHEXIDINE IN THAT ORDER. THE PROCEDURE WAS STARTED WITH ANOTHER SAFETY CHECKLIST AND A TIMEOUT. PROCEDURE: THE MAZOR ROBOT HAD BEEN ATTACHED TO THE JACKSON 4 POST AND SECURED. AFTER PREP AND DRAPE IS BEEN COMPLETED AS PREVIOUSLY MENTIONED THE ROBOT WAS ALSO DRAPED IN. BONE MARROW ASPIRATION WAS COMPLETED USING A STANDARD TECHNIQUE USING THE ASPIRATION NEEDLE. 5 CC OF BONE MARROW ASPIRATE WAS TAKEN FROM THE POSTERIOR SUPERIOR ILIAC SPINE. A PERC PIN WAS INSERTED USING A SCHANZ PIN TO THE POSTERIOR SUPERIOR AC SPINE. THE ROBOT ARM WAS THEN SUBSEQUENTLY BROUGHT IN AND ATTACHED TO THE PERCUTANEOUS PIN. A TOWEL WAS PLACED OVER THE ROBOT ARM AND THE 3DEFINE WAS TAKEN WITH INSTRUMENTS BEING REGISTERED AT THE SAME TIME. A SNAPSHOT WAS THEN SUBSEQUENTLY TAKEN WITH THE GINGERBREAD ATTACHMENT SUBSEQUENT TO THIS A CEPHALAD AND CAUDAD REGISTRATION WAS COMPLETED SUBSEQUENTLY THE X-RAY ATTACHMENT WAS ATTACHED AND X-RAY IN THE AP AND OBLIQUE PLANES WERE TAKEN. ONCE COMPLETED VERIFICATION WAS COMPLETED AND CONFIRMED TO MAKE SURE THAT THE CT-PREOPERATIVE AND INTRAOPERATIVE FLUOROSCOPY IMAGES OVERLAPPED WITH NO SHIFT. ONCE SATISFIED THE PROCEDURE WAS STARTED PERFORMING THE TLIF FIRST THE PROCEDURE WAS STARTED BY BRINGING THE MICROSCOPE IN AND DISSECTION CONTINUED TO REMOVE THE SOFT TISSUE OF THE FACET AS WELL AS THE LAMINA AS WELL AS THE PAN. THE TLF WAS PLANNED TO BE PERFORMED FROM THE NIGHT SIDE AND PERFORM THE LAMINECTOMY AT THE SAME SITE AS WELL WHERE THE PATIENT WAS SYMPTOMATIC SUBSEQUENT TO THIS USING AN OSTEOTOME THE INFERIOR-ARTICULAR PROCESS OF L4 WAS REMOVED AFTER REMOVING THE TACET CAPSULE. THEN SUBSEQUENTLY THE SUPERIOR ARTICULAR PROCESS OF LS WAS REMOVED. SUBSEQUENT TO THIS USING A HIGH-SPEED BUT THE PARS WAS THINNED ALONG WITH THE REMAINING FACET. THE KERRISON WAS USED TO REMOVE THE PARS AS WELL AS THE FACET TO BE ABLE TO GET TO THE DOC SPACE. THE EXITING NERVE ROOT OF 14 WAS VISUALIZED AND PROTECTED WELL. METICULOUS HEMOSTASIS MAINTAINED. THE DISC WAS VISUALIZED AFTER CAUTERIZING THE EPIDURAL VEINS USING BIPOLAR. THE KAMBIN'S TRIANGLE WAS IDENTIFIED VISUALIZED NAVIGATED POINTER WAS PERIODICALLY USED TO CONFIRM LOCATION. A BOX CUT WAS MADE USING A 11 BLADE CAREFULLY PROTECTING THE NERVE ROOT THE DISC WAS REMOVED. SEQUENTIALLY SHAVERS AS WELL AS CURETTES WERE USED TO REMOVE THE DISC. ONCE SATISFIED WITH THE AMOUNT OF DISC PROP AS WELL AS THE POSITION OF THE TRIAL DEMINERALIZED BONE MATRIX GRAFT ON AS WELL AS PATIENT'S OWN AUTOGRAFT WAS PACKED VENTRAL TO THE FINAL PLACEMENT OF THE DISC. THE FINAL IMPLANT WAS IMPACTED INTO POSITION UNDER THE HELP OF DIRECT FLUOROSCOPY AS WELL AS PROTECTING THE NERVE MOT AND PROTECTING THE THECAL SAC. LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY: AFTER THE CAGE WAS INSERTED THE LAMINA WAS VISUALIZED IN THE OPERATIVE FIELD USING A KERRISON THE LAMINA WAS REMOVED EXPOSING THE LIGAMENTUM FLAVUM. PROTECTING THE THECAL SAC THE LIGAMENTUM FLAVUM WAS REMOVED ON THE IPSILATERAL SIDE CENTRAL AS WELL AS CONTRALATERAL SUBARTICULAR SPACE TO BE ABLE TO EXPOSE THE ENTIRE THECAL SAC IN THIS AREA THE LAMINECTOMY WAS PROCEEDED TO BLOW THE TRAVERSING NERVE ROOT BELOW TO ENSUE THERE IS NO PRESSURE. ONCE SATISFIED THAT THERE WAS ADEQUATE CENTRAL DECOMPRESSION AS WELL AS IPSILATERAL AND CONTRALATERAL SUBARTICULAR DECOMPRESSION COPIOUS IRRIGATION WAS USED CONTRALATERAL SUBARTICULAR REGION WAS DECOMPRESSED. THERE WAS ADEQUATE AMOUNT OF ROOM CEPHALAD CAUDAD AS WELL AS THE TRAVERSING NERVE ROOT OF L5 WAS VISUALIZED. THIS WAS FOUND TO BE FREE OF ANY COMPRESSION. THE ROBOT ARM WAS BROUGHT TO PLACING THE PEDICLE SCREWS STARTING ON THE RIGHT. A APPROPRIATE LENGTH INCISION WAS MADE USING THE AVAILABLE LARGE 10 BLADE WHICH WAS PLACED THROUGH THE ROBOTIC ARM. SKIN AND SUBCUTANEOUS TISSUE AND FASCIA WAS OPENED. SUBSEQUENT TO THIS A DILATOR WAS PLACED. THE TROCAR WAS REMOVED AND THE DILATOR LEFT IN PLACE. SUBSEQUENTLY THE DILATOR WAS PULLED BACK GENTLY BY A MILLIMETER OR SO TO AVOID SKIVE. SUBSEQUENT TO THIS AN AW TIP TAP INSERTED AND DRILLED WITH THE SOFTWARE OF THE ROBOT BEING USED TO CHECK TO ENSURE THAT THERE WAS NO BREACH. ONCE SATISFIED AN APPROPRIATE LENGTH SCREW WAS CHOSEN AND INSERTED AFTER REMOVING THE DILATOR. THE SAME TECHNIQUE WAS PERFORMED FOR AT THE LEVELS FROM LA AND LS. THE CAPS WERE PLACED OVER THE TOWERS. X-RAY WAS THEN SUBSEQUENTLY BROUGHT IN TO CONFIRM ON AP AND LATERAL PLANE TO CHECK TO ENSURE THAT OUR SCREW PLACEMENT WAS APPROPRIATE THE SAME TECHNIQUE WAS PERFORMED FOR THE LEFT SIDE AS WELL. WE THEN SUBSEQUENTLY WONT ON TO PLACE THE PERCUTANEOUS ROD. XRAY WAS TAKEN FINALLY TO CONFIRM FINAL SCREW POSITIONING. SUBSEQUENT TO THIS USING A CALIPER THE LENGTH OF THE ROD WAS CHOCKED. SUBSEQUENT TO THIS THE APPROPRIATE LENGTH ROD WAS INSERTED BILATERALLY FINAL X-RAYS WERE TAKEN ONCE AGAIN TO CONFIRM THAT THE RODS WERE CAPTURED FINAL TIGHTENING COMPLETED- AND THE EXTENSIONS BROKEN OFF AND CHECK IN THE BACK TABLE AND CONFIRMED TO HAVE EQUAL LENGTH. FINAL X-RAY TAKEN. WE USED SPECIFIC CAPTURED RODS. IRRIGATION WAS THEN USED WITH IODINE COMBINED WITH SALINE. CLOSURE WAS MADE AFTER METICULOUS HEMOSTASIS AND WITH COPIOUS IRRIGATION USING #1 PDS WAS USED TO REAPPROXIMATE THE FASCIA 2-0 PDS WAS USED TO REAPPROXIMATE THE SUBCUTANEOUS TISSUE AND 2-0 NYLON USING A WHIPSTITCH VANCOMYCIN WAS PLACED IN THE SUBFASCIAL REGION AS WELL AS AVITENE FOR HEMOSTASIS. A AQUACEL DRESSING WAS APPLIED, A STERILE DRESSING PLACED ON TOP OF IT OR COUNTS, INSTRUMENT COUNTS AND WAS SPONGE COUNT FOUND TO BE CORRECTED. ALLERGIES, ADVERSE REACTIONS, ALERTS ; DT. (B)(6)2022 SUBSTANCE: GABAPENTIN REACTION: BLURRY VISION; SEVERITY- MODERATE; STATUS: ACTIVE SUBSTANCE: POLLEN REACTION: CONGESTION; SEVERITY: MODERATE; STATUS: ACTIVE ASSESSMENT AND PLAN: PAIN WELL CONTROLLED OVERNIGHT. DIFFICULTY AMBULATING REQUIRED ASSISTANCE TO RESTROOM. DENIES FEVERS, CHILLS, S WEAT, DYSPNEA ASSESSMENT/ PLAN : ORDERED RADIOLOGY REPORTS EXAM DATE TIME: (B)(6) 2022 PROCEDURE: L SPINE >4 VIEW NOTES: (L SPINE >4 VIEW) REASON FOR EXAM: S/P L4-5 TLIF, PSIF SPINE LUMBOSACRAL 2 VIEW STUDY: 2 VIEW RADIOGRAPHS OF THE LUMBAR SPINE HISTORY: POSTOP LUMBAR FUSION. COMPARISON: RADIOGRAPHS OF LUMBAR SPINE DATED (B)(6)2022. FINDINGS: DECREASED BONE MINERALIZATION OF THE LUMBAR SPINE. THERE ARE 5 NON RIB-BEARING LUMBAR TYPE VERTEBRAL BODIES. POSTSURGICAL CHANGES RELATED TO TRANSFORAMINAL LUMBAR INTERBODY FUSION AND POSTERIOR SPINAL INTERBODY FUSION OF L4-5 WITH INTERVERTEBRAL BODY DISC SPACER. NO PERI HARDWARE LUCENCIES OR HARDWARE FRACTURES. ADDITIONAL POSTSURGICAL CHANGES RELATED TO 3 INTRA-ARTICULARCAGE DEVICE OF THE RIGHT SACROILIAC JOINT AND LEFT TOTAL HIP ARTHROPLASTY. NO ACUTE FRACTURE OR DISLOCATION. THE LEFT SACROILIAC JOINT AND SYMPHYSIS PUBIS ARE PATENT WITHOUT WIDENING. IMPRESSION: POSTSURGICAL CHANGES RELATED TO TLIF AND PSIF OF L4-L5 WITHOUT ACUTE HARDWARE COMPLICATIONS. EXAM DATE/TIME: (B)(6)2022 REASON FOR EXAM: (L SPINE >4 VIEW) OR 22 C-ARM (L4-5 FUSION) REPORT: RESULT: HISTORY: OR 22 C-ARM (L4-5 FUSION) REPORT: STUDY: 2 INTRAOPERATIVE FLUOROSCOPIC IMAGES OF THE SPINE LUMBOSACRAL 2 VIEW WERE OBTAINED. COMPARISON: LUMBAR SPINE CT FROM (B)(6)2022 FINDINGS/IMPRESSIONS: INTRAOPERATIVE IMAGES OF THE LUMBOSACRAL SPINE WERE OBTAINED FOR LOCALIZATION OF THE SURGICAL HARDWARE DURING POSTERIOR SEGMENT SPINAL FUSION. THE TOTAL FLUOROSCOPY TIME IS 38.3 SECONDS. CUMULATIVE DOSE: 19.72 MGY. THE RADIOLOGIST WAS NOT IN ATTENDANCE DURING THE PROCEDURE. REHAB REPORTS : (B)(6)2022 ASSESSMENT - OCCUPATIONAL THERAPY: MRS. MENCH RESENTED TO BUMC S/P LUMBAR LAMI. PT IS SLIGHTLY BELOW BASELINE STATUS REQUIRING UP TO MOD FOR BED MOB, MIN A FOR LB ADLS, CGA FOR TRANSFERS W/ FWW DUE TO PAIN, AND SBA TO AMBULATE W/ FWW. PTS MAIN BARRIER IS PAIN, NEW SPINAL PRECAUTIONS, AND DECREASED STANDING BALANCE. BARTHEL INDEX OF ACTIVITIES OF DAILY LIVING: 14/20 INDICATING MINIMAL DEPENDENCY ON OTHERS FOR SAFE COMPLETION OF ADLS, TRANSFERS, AND MOBILITY. PT IS MEDICALLY APPROPRIATE TO BE SEEN BY SKILLED OT SERVICES UP TO 5X A WEEK, FOR LENGTH OF STAY OR UNTIL GOALS MET. D/C REC: HOME WITH ASSIST AND FWW EXAM DATE: (B)(6)2022 PATIENT STATUS: OUTPATIENT EXAM TYPE: PVL VENOUS ULTRASOUND UNILATERAL LOWER PROCEDURES): A NON-INVASIVE VASCULAR DUPLEX IMAGING STUDY OF THE LOWER EXTREMITY VEINS WAS PERFORMED USING TWO-DIMENSIONAL EVALUATION, COLOR FLOW AND SPECTRAL DOPPLER ANALYSIS. TECHNICAL QUALITY: DIAGNOSTIC QUALITY HISTORY/RISK FACTORS: RECENT BACK SURGERY(12 DAYS AGO) CONCLUSIONS: NO EVIDENCE OF LEFT LOWER EXTREMITY DEEP VENOUS THROMBOSIS.
MEDICAL DECISION MAKING (B)(6) IS A 76-YEAR-OLD FEMALE PLEASANT PATIENT WITH NEUROGENIC CLAUDICATION AND LUMBAR RADICULOPATHY. THE PATIENT HAS FAILED NONSURGICAL MANAGEMENT MEASURES AND IS REQUESTING SURGICAL INTERVENTION. WE WENT OVER THE GOALS OF SURGERY IN DETAIL AND THE REASONS FOR WITH SURGERY IS INDICATED. DISCUSSED THAT SURGERY IS NOT MEANT FOR BACK PAIN IMPROVEMENT BUT RATHER IT HELPS WITH IMPROVEMENT OF WALKING DISTANCE TO IMPROVE THE CLAUDICATION AS WELL AS RADICULOPATHY PLAN: 1. PROCEED WITH OR TODAY (3/23) FOR L4-5 LAMINECTOMY WITH TLIF 2. ADMIT TO ORTHOPAEDIC SPINE TEAM POSTOP. IMAGING RESULTS NO QUALIFYING DATA AVAILABLE. DIAGNOSTIC RADIOLOGY L SPINE >4 VIEW (B)(6) 2022 REASON FOR EXAM (L SPINE >4 VIEW) S/P L4-5 TLIF, PSIF REPORT: STUDY: 2 VIEW RADIOGRAPHS OF THE LUMBAR SPINE HISTORY: POSTOP LUMBAR FUSION. REPORT: COMPARISON: RADIOGRAPHS OF LUMBAR SPINE DATED (B)(6) 2022. FINDINGS: DECREASED BONE MINERALIZATION OF THE LUMBAR SPINE. THERE ARE 5 NONRIB-BEARING LUMBAR TYPE VERTEBRAL BODIES. POSTSURGICAL CHANGES RELATED TO TRANSFORAMINAL LUMBAR INTERBODY FUSION AND POSTERIOR SPINAL INTERBODY FUSION OF L4-5 WITH INTERVERTEBRAL BODY DISC SPACER. NO PERIHARDWARE LUCENCIES OR HARDWARE FRACTURES. ADDITIONAL POSTSURGICAL CHANGES RELATED TO 3 INTRA-ARTICULAR CAGE DEVICE OF THE RIGHT SACROILIAC JOINT, AND LEFT TOTAL HIP ARTHROPLASTY. NO ACUTE FRACTURE OR DISLOCATION. THE LEFT SACROILIAC JOINT AND SYMPHYSIS PUBIS ARE PATENT WITHOUT WIDENING. IMPRESSION: POSTSURGICAL CHANGES RELATED TO TLIF AND PSIF OF L4-L5 WITHOUT ACUTE HARDWARE COMPLICATIONS. L SPINE >4 VIEW: (B)(6) 2022 REASON FOR EXAM (L SPINE >4 VIEW) OR 22 C-ARM (L4-5 FUSION) REPORT: RESULT: HISTORY: OR 22 C-ARM (L4-5 FUSION) REPORT: STUDY: 2 INTRAOPERATIVE FLUOROSCOPIC IMAGES OF THE SPINE LUMBOSACRAL 2 VIEW WERE OBTAINED. COMPARISON: LUMBAR SPINE CT FROM (B)(6) 2022 FINDINGS/IMPRESSION: INTRAOPERATIVE IMAGES OF THE LUMBOSACRAL SPINE WERE OBTAINED FOR LOCALIZATION OF THE SURGICAL HARDWARE DURING POSTERIOR SEGMENT SPINAL FUSION. THE TOTAL FLUOROSCOPY TIME IS 38.3 SECONDS. CUMULATIVE DOSE: 19.72 MGY. THE RADIOLOGIST WAS NOT IN ATTENDANCE DURING THE PROCEDURE. THE IMAGES ARE NOT INTENDED FOR DIAGNOSTIC PURPOSES. (B)(6) 2022 SUBJECTIVE PAIN WELL CONTROLLED OVERNIGHT. DIFFICULTY AMBULATING, REQUIRED ASSISTANCE TO RESTROOM. DENIES FEVERS, CHILLS, SWEATS, DYSPNEA. (B)(6) 2022 BRIEF HPI AND REASON FOR HOSPITALIZATION REFER TO H<(>&<)>P FOR DETAILS. PROCEDURES L4-5 TLIF, LAMINECTOMY AND POSTERIOR INSTRUMENTATION ((B)(6) 2022) INTAKE AND OUTPUT I / O TOTAL LAST 24HRS INPUT: 2888.18 ML OUTPUT: 525.00 ML TOTAL I/O: 2363.18 ML ASSESSMENT/PLAN BACK PAIN ASSESSMENT: 76-YEAR-OLD FEMALE WHO UNDERWENT TRANSFORAMINAL LUMBAR INTERBODY FUSION L4-5 WITH LUMBAR LAMINECTOMY AND L4-5 PSIF ON (B)(6) 2022 WITH THE POSTOPERATIVE COMPLICATION OF EXTRUDED INTERBODY DEVICE, REQUIRING URGENT SURGICAL INTERVENTION ON 5/5. PATIENT IS NOW STATUS POST REMOVAL OF HARDWARE VIA POSTERIOR APPROACH, AND ANTERIOR LUMBAR INTERBODY FUSION L4-5 WITH ASSISTANCE OF VASCULAR SURGERY. IMAGING: UPRIGHT LUMBAR AP/LATERAL X-RAY PRIOR TO DISCHARGE PLAN: -VASCULAR SURGERY ASSISTED IN APPROACH. WE APPRECIATE THEIR RECOMMENDATIONS. -ACTIVITY/WBS: NO LIFTING PAST 5 LBS, NO DEEP FORWARD BENDING, TWISTING OR TURNING (FOR ABOUT 3 MONTHS). NO WALKING RESTRICTIONS. -ANTIBIOTICS: PERIOPERATIVE ANCEF -ANALGESIA: OXYCODONE 5-10 MG EVERY 4 HOURS AS NEEDED, TYLENOL, GABAPENTIN, ROBAXIN (TWO WEEKS). PCA OVERNIGHT -ANTICOAGULATION: RECOMMEND AMBULATION. NO ANTICOAGULATION FOR 24 HOURS POSTOPERATIVELY. WILL START LOVENOX 40 MG DAILY 5/7 AM AND CONTINUE FOR 28 DAYS POSTOPERATIVELY. -DRESSINGS: AQUACEL -DIET: START CLEAR LIQUIDS WITH SLOW ADVANCE OF DIET -LINES: D/C FOLEY POD1 -DRAIN: NONE -THERAPY: PTOT -ADDITIONAL PROCEDURES: NONE PLANNED -DISPOSITION (B)(6) 2022 CHIEF COMPLAINT PT C/O RIGHT SIDE LEG PAIN, STATES WAS TOLD TO COME TO ED FOR SURGERY. HAD XRAY DONE LAST WEEK AND SHOWS SCREW CAME OUT, HAD SPINAL FUSION IN MARCH ON L3, L4. SUBJECTIVE 76 YEAR-OLD FEMALE WITH HISTORY SIGNIFICANT FOR HTN, HLD, PRIOR LLE DVT, HYSTERECTOMY/OOPHORECTOMY, RADICULOPATHY/NEUROGENIC LAUDICATION/BACK PAIN S/P 3 PRIOR SURGERIES, MOST RECENT POSTERIOR L4-L5 ON (B)(6) 2022 NOW POD1 FROM REMOVAL OF POSTERIOR HARDWARE AND ALIF WITH VASCULAR SURGERY TEAM APPROACH FOR ALIF. -PATIENT STATES FEELING WELL THIS AM -STATES PAIN IS 8/10 BUT ALSO WELL CONTROLLED AND NOT NEEDING TO USE PCA BUTTON MUCH -DENIES NAUSEA/VOMITING, STATES SHE IS PASSING GAS -NOT OUT OF BED YET (B)(6) 2022 SUBJECTIVE: NO ACUTE EVENTS OVERNIGHT PAIN WELL CONTROLLED, PATIENT FEELS THAT HER RIGHT LOWER EXTREMITY PARESTHESIAS AND BURNING PAIN IS IMPROVING. AFEBRILE AND HEMODYNAMICALLY STABLE HAS BEEN TOLERATING FLUIDS WELL AND HAD SOME FISH YESTERDAY WITHOUT NAUSEA OR VOMITING, HAS YET TO HAVE A BOWEL MOVEMENT ASSESSMENT/PLAN: ASSESSMENT: 76-YEAR-OLD FEMALE WHO UNDERWENT TRANSFORAMINAL LUMBAR INTERBODY FUSION L4-5 WITH LUMBAR LAMINECTOMY AND L4-5 PSIF ON (B)(6) 2022 WITH THE POSTOPERATIVE COMPLICATION OF EXTRUDED INTERBODY DEVICE, REQUIRING URGENT SURGICAL INTERVENTION ON 5/5. PATIENT IS NOW STATUS POST REMOVAL OF HARDWARE VIA POSTERIOR APPROACH, AND ANTERIOR LUMBAR INTERBODY FUSION L4-5 WITH ASSISTANCE OF VASCULAR SURGERY. DOING WELL AND PROGRESSING POSTOPERATIVELY, PAIN IS IMPROVING AND SHE HAS BEEN AMBULATING WITH PT, IS PROGRESSING WITH HER DIET AND IS NOW UP TO SOME SOLIDS, STILL HAS NOT HAD A BOWEL MOVEMENT. PLAN: -VASCULAR SURGERY ASSISTED IN APPROACH. WE APPRECIATE THEIR RECOMMENDATIONS. -ACTIVITY/WBS: NO LIFTING PAST 5 LBS, NO DEEP FORWARD BENDING, TWISTING OR TURNING (FOR ABOUT 3 MONTHS). NO WALKING RESTRICTIONS. -ANALGESIA: OXYCODONE 5-10 MG EVERY 4 HOURS AS NEEDED, TYLENOL, GABAPENTIN, ROBAXIN (TWO WEEKS). -ANTICOAGULATION: RECOMMEND AMBULATION. WILL START LOVENOX 40 MG DAILY TODAY AM AND CONTINUE FOR 28 DAYS POSTOPERATIVELY. -DRESSINGS: AQUACEL -DIET: ADVANCE DIET AS TOLERATED -THERAPY: PTOT RECOMMENDING HOME WITH HOME HEALTH PT -ADDITIONAL PROCEDURES: NONE PLANNED (B)(6) 2022 CHIEF COMPLAINT PT C/O RIGHT SIDE LEG PAIN, STATES WAS TOLD TO COME TO ED FOR SURGERY. HAD XRAY DONE LAST WEEK AND SHOWS SCREW CAME OUT, HAD SPINAL FUSION IN MARCH ON L3, L4. SUBJECTIVE NO ACUTE EVENTS OVERNIGHT. PATIENT IS DOING WELL THIS MORNING AND PAIN IS CURRENTLY WELL CONTROLLED. DENIES FEVER, CHILLS, SHORTNESS OF BREATH. PHYSICAL EXAM GENERAL: PATIENT RESTING COMFORTABLY, NO ACUTE DISTRESS HEENT: NORMOCEPHALIC, ATRAUMATIC CARDIO: REGULAR RATE RESPIRATORY: NORMAL WORK OF BREATHING, NO AUDIBLE WHEEZING. NEURO/PSYCH: NORMAL BEHAVIOR, NORMAL AFFECT, NO FOCAL DEFICITS, ABLE TO ANSWER QUESTIONS AND FOLLOW COMMANDS APPROPRIATELY MUSCULOSKELETAL. ¿AQUACEL OVER ANTERIOR LOWER ABDOMEN WITH SCANT SEROSANGUINEOUS SATURATION ¿ BILATERAL LOWER EXTREMITIES REVEAL INTACT HIP FLEXION/KNEE EXTENSION/ANKLE PLANTAR AND DORSI FLEXION/TOE FLEXION AND EXTENSION ¿ SENSATION INTACT IN ALL DERMATOMES BUT SLIGHTLY DECREASED IN RIGHT SIDED L5 DISTRIBUTION COMPARED TO THE CONTRALATERAL ¿ TOES WARM AND WELL-PERFUSED. MEDICAL DECISION MAKING 76-YEAR-OLD FEMALE WHO UNDERWENT TRANSFORAMINAL LUMBAR INTERBODY FUSION L4-5 WITH LUMBAR LAMINECTOMY AND L4-5 PSIF ON (B)(6) 2022 WITH THE POSTOPERATIVE COMPLICATION OF EXTRUDED INTERBODY DEVICE, REQUIRING URGENT SURGICAL INTERVENTION ON 5/5. PATIENT IS NOW STATUS POST REMOVAL OF HARDWARE VIA POSTERIOR APPROACH, AND ANTERIOR LUMBAR INTERBODY FUSION L4-5 WITH ASSISTANCE OF VASCULAR SURGERY. DOING WELL AND PROGRESSING POSTOPERATIVELY, PAIN IS IMPROVING AND SHE HAS BEEN AMBULATING WITH PT, IS PROGRESSING WITH HER DIET AND IS NOW UP TO SOME SOLIDS, STILL HAS NOT HAD A BOWEL MOVEMENT. PLAN: -VASCULAR SURGERY ASSISTED IN APPROACH. APPRECIATE THEIR RECOMMENDATIONS. -ACTIVITY/WBS: NO LIFTING PAST 5 LBS, NO DEEP FORWARD BENDING, TWISTING OR TURNING (FOR ABOUT 3 MONTHS). NO WALKING RESTRICTIONS. -ANALGESIA: OXYCODONE 5-10 MG EVERY 4 HOURS AS NEEDED, TYLENOL, GABAPENTIN, ROBAXIN (TWO WEEKS). -ANTICOAGULATION: RECOMMEND AMBULATION. LOVENOX 40 MG DAILY; CONTINUE FOR 28 DAYS POSTOPERATIVELY -DRESSINGS: AQUACEL -DIET: ADVANCE DIET AS TOLERATED -THERAPY: PTOT RECOMMENDING HOME WITH HOME HEALTH PT -ADDITIONAL PROCEDURES: NONE PLANNED -DISPOSITION: PENDING COORDINATION OF HH PT. ANTICIPATE DISCHARGE TODAY OR TOMORROW. ASSESSMENT/PLAN BACK PAIN NARRATIVE NOTE : ADMIT FOR INFECTED SPINAL HARDWARE-PT C/O RIGHT SIDE LEG PAIN, STATES WAS TOLD TO COME TO ED FOR SURGERY. HAD XRAY DONE LAST WEEK AND SHOWS SCREW CAME OUT, HAD SPINAL FUSION IN MARCH ON L3, L4 DCP-PENDING. PRE-OP DIAGNOSIS EXTRUDED L4-5 INTERBODY DEVICE WITH ANTEROLISTHESIS OF L4 ON L5 IN THE SETTING OF PRIOR PSIF WITH LUMBAR INTERBODY FUSION AND LAMINECTOMY FOR LUMBAR RADICULOPATHY AND NEUROGENIC CLAUDICATION POST-OP DIAGNOSIS: SAME PROCEDURE(S) PERFORMED REMOVAL OF HARDWARE: EXTRUDED L4-5 INTERBODY DEVICE VIA POSTERIOR APPROACH AND USE OF MICROSCOPE ANTERIOR LUMBAR INTERBODY FUSION L4-5 VIA ANTERIOR APPROACH WITH THE ASSISTANCE OF VASCULAR SURGERY, APPROACH TO BE DICTATED SEPARATELY. FINDINGS EXTRUDED L4-5 INTERBODY DEVICE RESTING NEAR THE RIGHT L4-5 NEUROFORAMEN SPECIMEN(S) REMOVED NONE ESTIMATED BLOOD LOSS 350 CC FLUIDS SEE ANESTHESIA RECORD ANESTHESIA GETA COMPLICATIONS NO COMPLICATIONS NOTED DURING REMOVAL OF HARDWARE PROCEDURE. PATIENT WAS SUBSEQUENTLY FLIPPED SUPINE FOR ANTERIOR APPROACH, AND TOWARDS THE END OF THE INSERTION OF THE ANTERIOR LUMBAR INTERBODY FUSION AT L4-5, THE RIGHT COMMON ILIAC VEIN WAS PARTIALLY TORN. HEMOSTASIS OBTAINED BY VASCULAR SURGERY WITH THE USE OF VASCULAR CLIPS. ASSESSMENT: 76-YEAR-OLD FEMALE WHO PRESENTED DIRECTLY FROM CLINIC AFTER PREVIOUSLY UNDERGOING TRANSFORAMINAL LUMBAR INTERBODY FUSION L4-5 WITH LUMBAR LAMINECTOMY AND L4-5 PSIF ON (B)(6) 2022, WHO SUBSEQUENTLY WAS FOUND TO HAVE EXTRUSION OF HER INTERBODY DEVICE INTO HER NEUROFORAMEN AT HER 6-WEEK POSTOPERATIVE APPOINTMENT, REQUIRING URGENT SURGICAL INTERVENTION. PATIENT IS NOW STATUS POST REMOVAL OF HARDWARE VIA POSTERIOR APPROACH, AND ANTERIOR LUMBAR INTERBODY FUSION L4-5 WITH ASSISTANCE OF VASCULAR SURGERY. IMAGING: UPRIGHT LUMBAR AP/LATERAL X-RAY PRIOR TO DISCHARGE PLAN: -VASCULAR SURGERY ASSISTED IN APPROACH AND IS AVAILABLE FOR ANY QUESTIONS OR CONCERNS. WE APPRECIATE THEIR RECOMMENDATIONS. -ACTIVITY/WBS: NO LIFTING PAST 5 LBS, NO DEEP FORWARD BENDING, TWISTING OR TURNING (FOR ABOUT 3 MONTHS). NO WALKING RESTRICTIONS. -ANTIBIOTICS: PERIOPERATIVE ANCEF -ANALGESIA: OXYCODONE 5-10 MG EVERY 4 HOURS AS NEEDED, TYLENOL, GABAPENTIN, ROBAXIN (TWO WEEKS). PCA OVERNIGHT -ANTICOAGULATION: RECOMMEND AMBULATION. NO ANTICOAGULATION FOR 24 HOURS POSTOPERATIVELY. -BRACES/SPLINTS: NONE -DRESSINGS: AQUACEL -DIET: NPO OVERNIGHT. ANTICIPATE CLEARS TOMORROW, WITH SLOW ADVANCE OF DIET -LINES: RECOMMEND D/C FOLEY POD1 -DRAIN: NONE -THERAPY: PTOT -ADDITIONAL PROCEDURES: NONE PLANNED -DISPOSITION: PATIENT WILL FOLLOW UP WITH DR. (B)(6) IN 2 WEEKS. DEPART UPDATED AND CHEDULERS NOTIFIED. PLEASE DO NOT HESITATE TO CALL WITH ANY QUESTIONS OR CONCERNS OR IF THE PATIENT'S NEUROLOGICAL EXAM CHANGES. PRE-OPERATIVE DIAGNOSIS: FAILED ORTHOPEDIC HARDWARE WITH EXTRUSION OF TLIF CAGE POST-OPERATIVE DIAGNOSIS: SAME INDICATIONS: THIS IS A PLEASANT 76-YEAR-OLD LADY WHO HAD AN UNCOMPLICATED TRANSFORAMINAL LUMBAR INTERBODY FUSION RECENTLY WITH POSTO P X-RAYS WHICH DID NOT SHOW ANY EVIDENCE OF ANY HARDWARE FAILURE. PATIENT WAS FOLLOWED IN THE OFFICE AND HER VISIT TODAY TO THE OFFICE AND X-RAY WAS OBTAINED WHICH SHOWS THAT THE TLIF CAGE HAD GOTTEN EXTRUDED POSTERIORLY. PATIENT HAD SOME LUMBAR RADICULOPATHY AND FOOT WEAKNESS AS A RESULT. THEREFORE THE PATIENT WAS ADMITTED TO THE HOSPITAL URGENTLY AND SURGICAL INTERVENTION WAS PLANNED TO REMOVE THE EXTRUDED CAGE AND TO DO AN ANTERIOR LUMBAR INTERBODY FUSION. AFTER COUNSELING FOR TREATMENT OPTIONS AFTER COUNSELING FOR EARLY, LATE, LOCAL AND SYSTEMIC COMPLICATIONS INFORMED WRITTEN CONSENT WAS OBTAINED FOR A STAGED PROCEDURE TO BE COMPLETED THE SAME DAY PROCEDURE: STAGE I WAS POSTERIOR REMOVAL OF FAILED TLIF CAGE: STAGE II WAS ANTERIOR LUMBAR INTERBODY FUSION WITH ALLOGRAFT AND INSTRUMENTATION CODES: ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE WITH DISCECTOMY TO PREPARE INTERSPACE-L4-L5-22558-62 ANTERIOR INSTRUMENTATION AT L4-L5-22846 PLACEMENT OF BIOMECHANICAL DEVICE-CAGE L4-L5 -22853 ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE WITH DISCECTOMY TO PREPARE INTERSPACE AT L4 L5-22585-62 ALLOGRAFT-20930 REMOVAL OF FAILED ORTHOPEDIC IMPLANT-22855 ANESTHESIA: GENERAL STAGE I POSITIONING: THE PATIENT WAS PLACED PRONE ON THE JACKSON 4 POST. THERE WAS NO PRESSURE ON THE GLOBES OF THE EYES BILATERALLY. THE CHEST WAS APPROPRIATELY PADDED AND PROTECTED. THE ABDOMEN WAS ALLOWED TO HANG FREE. ALL SUPERFICIAL BONY PROMINENCES AND NERVES WERE PADDED AND PROTECTED. THE EXTERNAL GENITALIA WAS FREE OF ANY PRESSURE. THE KNEES WERE SUPPORTED, IT GENTLY FLEXED WITH THE KNEE FLEXED WITH SUPPORTS AND PILLOWS. STAGE II POSITIONING: THE PATIENT WAS PLACED SUPINE ON A FLAT JACKSON. THE PATIENT¿S HEAD AND NECK WERE KEPT NEUTRAL. THE PATIENT¿S ARM WAS SUPPORTED ON AN ARM HOLDER. ALL SUPERFICIAL BONY PROMINENCES WERE PADDED AND PROTECTED. NEUROMONITORING: THE PATIENT HAD SSEP, RUNNING EMG WITH NO INTRAOPERATIVE SUSTAINED ABNORMALITIES. ANTIBIOTICS: THE PATIENT RECEIVED ANTIBIOTICS BASED ON THE ALLERGY PROFILE WITHIN AN HOUR OF THE PROCEDURE DEEP VEIN THROMBOSIS PROPHYLAXIS: INTRAOPERATIVE PAS BOOTS. ESTIMATED BLOOD LOSS: APPROXIMATELY 200 CC COMPONENTS: PATIENT HAD MEDTRONIC INSTRUMENTATION COMPLICATIONS: NONE POSTOPERATIVE PLAN: 1. THE PATIENT WILL BE ADMITTED TO THE FLOOR FOR IV ANTIBIOTICS FOR A TOTAL PERIOD OF 24 HOURS. 2. FOLEY WILL BE ATTEMPTED TO BE REMOVE POSTOP DAY 1. 3. DVT PROPHYLAXIS WILL CONSIST OF EARLY MOBILIZATION WITH PAS BOOTS. SUMMARY: THE PATIENT WAS SEEN IN THE PREOPERATIVE ANESTHETIC AREA, SURGICAL SITE MARKED. THE PATIENT WAS SUBSEQUENTLY TAKEN TO THE OR ON A GURNEY WHERE A PREINDUCTION TIMEOUT WAS PERFORMED. THE PATIENT HAD APPROPRIATE LINES INSERTED AND THE PATIENT POSITIONED AS PREVIOUSLY MENTIONED. PREP AND DRAPE WAS DONE AS PER STANDARD STERILE PRECAUTIONS USING ALCOHOL AND CHLORHEXIDINE AND ALLOWED TO DRY FOR 3 MINUTES. INTEGUSEAL SEAL WAS USED, AND THE ENTIRE OPERATIVE FIELD SKIN SURFACE WAS COVERED WITH IOBAN. AFTER PREP AND DRAPE THE PATIENT'S INCISION ON THE TLIF SITE WAS OPENED. SKIN SEPARATENESS TISSUE WAS SHARPLY OPENED, AND THE SCAR TISSUE FOLLOWED TO THE PEDICLE SCREWS. THE SCAR ON TOP OF THE PEDICLE SCREW WAS REMOVED AND THE SETSCREWS WERE EXPOSED. THE SETSCREWS WERE SUBSEQUENTLY REMOVED AND THE ROD REMOVED. SUBSEQUENT TO THIS THE TLIF SITE WAS EXPLORED CAREFULLY AND THE EXTRUDED CAGE VISUALIZED AND EXTRACTED WITHOUT ANY COMPLICATION. METICULOUS HEMOSTASIS MAINTAINED. SUBSEQUENTLY CLOSURE WAS COMPLETED IN LAYERS WITH #1 PDS USED FOR REAPPROXIMATING THE FASCIA, COMBINATION OF 2-0 PDS AND #1 PDS WAS USED FOR SUBCUTANEOUS TISSUE AND THE SKIN CLOSED WITH 2-0 NYLON IN A RUNNING WHIPSTITCH FASHION. SUBSEQUENT TO THIS THE PATIENT WAS TRANSFERRED CAREFULLY TO THE SUPINE POSITION AS PREVIOUSLY MENTIONED FOR THE ANTERIOR LUMBAR INTERBODY FUSION. ONCE SURGEON ALLOWED TO ACCESS TO THE L4-L5 DISC SPACE A NEEDLE WAS INSERTED TO MARK THE MIDDLE OF THE DISC SPACE. AN X-RAY AP AND LATERAL TAKEN IN ORTHOGONAL VIEWS TO ENSURE THAT WE WERE AT THE CORRECT LEVEL AS WELL AS MIDLINE. ONCE CONFIRMED SURGEON PROCEEDED TO PERFORM A THOROUGH DISCECTOMY AT THIS LEVEL. THIS WAS COMPLETED USING A COMBINATION OF COBB, PITUITARY AND CURETTES. USING TRIALS THE DISC SPACE WAS OPENED UP. FINALLY AN APPROPRIATE SIZE IMPLANT WAS CHOSEN. AFTER METICULOUS HEMOSTASIS, DEMINERALIZED BONE MATRIX WAS PLACED INSIDE THE DISC SPACE. THE CAGE WAS PACKED WITH A DEMINERALIZED BONE MATRIX. THE JIG WITH THE PLATE WAS ATTACHED TO THE CAGE WAS IMPACTED. USING THE JIG AND AWL WAS USED TO GAIN ACCESS INTO THE VERTEBRAL BODY OF L4 AND L5 WITH THE HELP OF LATERAL FLUOROSCOPY IMAGE. SUBSEQUENT TO THIS APPROPRIATE SIZE SCREWS WERE INSERTED. THEN SUBSEQUENTLY COPIOUSLY IRRIGATED THE WOUND. THE RETRACTORS WERE REMOVED. NO SIGNIFICANT BLEEDING WAS NOTICED. THE WOUND WAS DRY AT THE COMPLETION OF THE PROCEDURE. CLOSURE WAS COMPLETED BY OUR VASCULAR SURGERY TEAM. PLEASE REFER TO DETAILED NOTE WITH REGARDS TO THIS. A STERILE DRESSING WAS APPLIED, A STERILE DRESSING PLACED ON TOP OF IT. OR COUNTS, INSTRUMENT COUNTS AND WAS SPONGE COUNT FOUND TO BE CORRECTED. THE PATIENT WAS CHECKED IN THE RECOVERY ROOM WAS FOUND TO BE NEUROLOGICALLY SIMILAR COMPARED TO THE PREOPERATIVE EXAMINATION. DATE OF SERVICE: (B)(6)2022 PREOPERATIVE DIAGNOSIS: HISTORY OF L4-L5 LUMBAR INTERBODY FUSION FROM THE POSTERIOR WITH EXTRUDED CAGE. POSTOPERATIVE DIAGNOSIS: HISTORY OF L4-L5 LUMBAR INTERBODY FUSION FROM THE POSTERIOR WITH EXTRUDED CAGE. OPERATION: ANTERIOR LUMBAR INTERBODY FUSION. ANESTHESIA: GENERAL. INDICATIONS: SURGEON SAW THE PT. IN CLINIC AND NOTICED THAT HER POSTERIOR APPROACH L4-L5 FUSION ALL WHERE HE HAD THE HARDWARE, HAD EXTRUDED AND NEEDED TO BE REMOVED AND REPLACED WITH AN ANTERIOR APPROACH. HE ASKED ME TO HELP WITH THE CASE. COSURGEON PROVIDED THE EXPOSURE FOR THE L4-L5 REGION. THE PATIENT WAS ALREADY IN THE OR. DESCRIPTION OF PROCEDURE: AFTER THE POSTERIOR HARDWARE WAS REMOVED, THE PATIENT WAS FLIPPED AND HER ABDOMEN WAS PREPPED AND DRAPED IN A STERILE FASHION. AN ADDITIONAL TIMEOUT WAS OBSERVED OR RE-ENSURED HAD THE CORRECT HARDWARE AND EQUIPMENT. SURGEON STARTED OFF WITH AN X-RAY TO IDENTIFY THE L4-L5 INTERSPACE. THEN MADE AN INCISION FROM JUST BELOW HER UMBILICUS FROM HER MIDLINE LATERALLY TO THE LEFT LATERAL EDGE OF HER RECTUS. HE CARRIED THE INCISION WITH BOVIE CAUTERY DOWN TO THE ANTERIOR RECTUS SHEATH. HE THEN TRANSECTED THE ANTERIOR RECTUS SHEATH TRANSVERSELY. THEN RAISED FLAPS FOR THE ANTERIOR RECTUS SHEATH AND CIRCUMFERENTIALLY DISSECTED OUT THE RECTUS MUSCLE. THEN HER POSTERIOR RECTUS SHEATH WAS VERY MINIMAL AND APPEARED TO BE USED WITH HER RETROPERITONEUM. SHE DID HAVE A HISTORY OF A HYSTERECTOMY AS WELL AS OTHER PROCEDURES, WHICH MAY HAVE CONTRIBUTED, BUT I AM NOT SURE. HOWEVER, SURGEON ENTERED THE RETROPERITONEAL SPACE AND MOVED HER INTESTINES MEDIALLY AND IDENTIFIED THE PSOAS MUSCLE. THEN IDENTIFIED THE L4-L5 INTERSPACE. AFTER THIS, INSERTED THE CORRECT POSITIONING OF THE SPINAL NEEDLE WITH ANTERIOR AND LATERAL VIEWS WITH AN X-RAY. DURING THIS, THERE WERE A FEW SMALL RENT IN THE LEFT COMMON ILIAC VEIN, WHICH HAD ALL BEEN REMOVED MEDIALLY. SURGEON REPAIRED THEM WITH MULTIPLE CLIPS. AFTER ALL INSTRUMENTATION WAS COMPLETED, I THEN ENSURED ADEQUATE HEMOSTASIS, PLACED VANCOMYCIN AND AVITENE AFTER WASHING OF THE ABDOMEN TWICE. AND THEN CLOSED THE ANTERIOR RECTUS SHEATHWITH #1 PROLENE. HER 3-4 INCHES OF ADIPOSE TISSUE WITH 2-0 VICRYL, DEEP DERMAL TISSUE WITH 3-0 VICRYL, AND SKIN WITH MONOCRYL. ESTIMATED BLOOD LOSS FOR THE CASE WAS 300-400 ML OF BLOOD WAS MOSTLY LOST DURING REPAIR OF THE MULTIPLE SMALL RENT IN HER LEFT COMMON ILIAC VEIN. THE PATIENT WOKE UP, MOVING ALL EXTREMITIES. SHE WAS MOVED TO PACU IN STABLE CONDITION. PHONE SCREENED FOR LUMBAR LAMI AND FUSION SCHEDULED (B)(6) 2022. PT REPORTS HX OF POST OP NAUSEA AND SEVERE CONSTIPATION. AMB WITH A CANE 2/2 BACK PAIN AND UNSTEADY GAIT. PT WAS EVALUATED BY OUTSIDE CARDS (B)(6) 2020 FOR HIP ARTHROPLASTY AND AT THAT TIME "LOW RISK". STATES NO CHANGES IN HER BASELINE (OTHER THAN INCREASED BACK PAIN) SINCE THEN. PT TESTED + FOR COVID (B)(6) 2022 AND HAS BEEN ASYMPTOMATIC. POSITIVE COVID TEST (B)(6)2022. PT ASYMPTOMATIC PROCEDURE DATE RELATED DIAGNOSIS BODY SITE STATUS SPINAL HARDWARE REMOVAL: (B)(6) 2022 COMPLETED WITH ANTERIOR LUMBAR INTERBODY FUSION (L-4, L-5): (B)(6) 2022 COMPLETED LUMBAR LAMINECTOMY (L-4, L-5): (B)(6) 2022 COMPLETED LUMBAR SPINAL FUSION (L-4, L-5): (B)(6) 2022 COMPLETED WITH INSTRUMENTATION (L-4, L-5): (B)(6) 2022 COMPLETED PAIN PROCEDURE: (B)(6) 2021 COMPLETED COLONOSCOPY :(B)(6) 2019 COMPLETED EXAM DATE: (B)(6) 2022 PROCEDURE: L SPINE >4 VIEW NOTES: (L SPINE >4 VIEW) REASON FOR EXAM: POSTOP EVAL SPINE LUMBOSACRAL 2 VIEW RESULT: HISTORY: POSTOP EVAL COMPARISON: INTEROPERATIVE IMAGES OF THE LUMBOSACRAL SPINE FROM (B)(6) 2022 TECHNIQUE: SPINE LUMBOSACRAL 2 VIEW FINDINGS: DIFFUSE DECREASED BONE MINERALIZATION. THERE ARE 5 NONRIB-BEARING LUMBAR TYPE VERTEBRAE. POSTSURGICAL CHANGES STATUS POST L4-5 POSTERIOR INSTRUMENTED SPINAL FUSION VISION WITH INTERVAL REMOVAL OF THE INTERVERTEBRAL BODY DISC SPACER AND PLACEMENT OF L4-5 ANTERIOR LUMBAR INTERBODY FUSION DEVICE. NO EVIDENCE OF IMMEDIATE HARDWARE COMPLICATIONS. ALIGNMENT INCLUDING THE RIGHT FUSION ROD IS SIMILAR TO INTEROPERATIVE IMAGES. THE CAGE DEVICES AT THE RIGHT SACROILIAC JOINT AND INCOMPLETELY EVALUATED LEFT TOTAL HIP ARTHROPLASTIES ARE AGAIN SEEN AND SIMILAR TO PRIOR EXAM. THERE IS NO ACUTE FRACTURE OR DISLOCATION OF THE LUMBAR SPINE. PROBABLE SURGICAL STAPLES PROJECT ANTERIOR TO THE LUMBOSACRAL JUNCTION. SCATTERED ATHEROSCLEROTIC CALCIFICATIONS. IMPRESSION: POSTSURGICAL CHANGES STATUS POST L4-5 POSTERIOR INSTRUMENTED SPINAL FUSION VISION WITH INTERVAL REMOVAL OF THE INTERVERTEBRAL BODY DISC SPACER AND PLACEMENT OF L4-5 ANTERIOR LUMBAR INTERBODY FUSION DEVICE. NO EVIDENCE OF IMMEDIATE HARDWARE COMPLICATIONS. ALIGNMENT INCLUDING THE RIGHT FUSION ROD IS SIMILAR TO INTEROPERATIVE IMAGES. PROCEDURE: ABDOMEN SINGLE VIEW KUB NOTES: (ABDOMEN SINGLE VIEW KUB) REASON FOR EXAM: RISK BASED IMAGING ABDOMEN SINGLE VIEW KUB KUB CLINICAL INDICATION: EVALUATE FOR FOREIGN BODY TECHNIQUE: SINGLE SUPINE VIEW OF THE ABDOMEN WAS OBTAINED. COMPARISON: CT LUMBAR SPINE (B)(6) 2022 FINDINGS: GASEOUS DISTENTION OF THE STOMACH. OTHERWISE NONSPECIFIC, NONOBSTRUCTIVE BOWEL GAS PATTERN. NO DEFINITE PNEUMOPERITONEUM IS SEEN. THE VISIBLE OSSEOUS STRUCTURES ARE AGE-APPROPRIATE. ORGANOMEGALY OR MASSES NOT APPRECIATED. ABNORMAL CALCIFICATIONS WERE NOT APPRECIATED. SIMILAR APPEARANCE OF 3 INTRA-ARTICULAR CAGE DEVICES OF THE RIGHT SACROILIAC JOINT, LEFT TOTAL HIP ARTHROPLASTY, AND L4-L5 SPINAL FUSION HARDWARE. IMPRESSION: 1. UNCHANGED APPEARANCE OF EXPECTED SURGICAL HARDWARE. NO EVIDENCE OF METALLIC FOREIGN BODY. 2. DIFFUSE GASEOUS DISTENTION OF THE STOMACH WHICH APPEARS NEW SINCE CT ABDOMEN EARLIER IN THE SAME DAY. THIS COULD BE SEEN IN THE SETTING OF POSTPRANDIAL STATE OR DELAYED EMPTYING. NOTES: (L SPINE >4 VIEW) REASON FOR EXAM: OR 18 LUMBAR SPINE SPINE LUMBOSACRAL 2 VIEW RESULT: HISTORY: EXTRUDED L4-L5 INTERBODY DEVICE WITH ANTEROLISTHESIS OF L4 ON L5 STUDY: 6 FRONTAL AND LATERAL INTRAOPERATIVE FLUOROSCOPIC IMAGES OF THE LUMBOSACRAL SPINE WERE OBTAINED. THE IMAGES WERE OBTAINED BY THE RADIOLOGY TECHNOLOGIST FOR THE PERFORMING SURGEON FOR LOCALIZATION OF THE SURGICAL HARDWARE. THE RADIOLOGIST WAS NOT IN ATTENDANCE DURING THE PROCEDURE. THE IMAGES ARE NOT INTENDED FOR DIAGNOSTIC PURPOSES. COMPARISON: LUMBOSACRAL RADIOGRAPHS MAY 5, 2022 FINDINGS: THE IMAGES SHOW DISC ARTHROPLASTY REVISION. THE TOTAL FLUOROSCOPY TIME WAS 127.6 SECONDS. IMPRESSION: INTRAOPERATIVE IMAGES OF THE LUMBOSACRAL SPINE DURING DISC ARTHROPLASTY REVISION. THE RADIOLOGIST WAS NOT IN ATTENDANCE DURING THE PROCEDURE. THE IMAGES ARE NOT INTENDED FOR DIAGNOSTIC PURPOSES. CT LUMBAR SPINE W/O CONTRAST EXAM: CT LUMBAR SPINE W/O CONTRAST INDICATION: HARDWARE FAILURE. COMPARISONS: CT LUMBAR SPINE (B)(6) 2022. LUMBOSACRAL RADIOGRAPHS (B)(6) 2022. TECHNICAL PARAMETERS: SSDE: 30.8 MGY CTDIVOL BODY: 26.4 MGY DLP BODY: 1053.2 MGY-CM. TECHNIQUE: CONTIGUOUS AXIAL CT IMAGES THROUGH THE LUMBAR SPINE WERE OBTAINED WITHOUT CONTRAST. SAGITTAL AND CORONAL REFORMATS WERE GENERATED. 3D REFORMATS WERE NOT PERFORMED. CONTRAST: NONE. RADIATION DOSE: 1058. FINDINGS: REDEMONSTRATED POSTSURGICAL CHANGES RELATED TO TRANSFORAMINAL LUMBAR INTERBODY FUSION AND POSTERIOR SPINAL INTERBODY FUSION OF L4-L5 WITH INTERVERTEBRAL BODY SPACER. SPACING DEVICE APPEARS POSTERIORLY AND LATERALLY DISPLACED TO THE RIGHT EXTENDING INTO THE RIGHT LATERAL RECESS AND NEURAL FORAMINA. NO OTHER EVIDENCE OF HARDWARE COMPLICATION. SIMILAR APPEARANCE OF MILD L4 ANTEROLISTHESIS ON L5. MULTILEVEL DEGENERATIVE CHANGES OF THE VISUALIZED SPINE. DIFFUSE DISC BULGE SEEN AT THE L2-L3 DISC LEVEL WITH SEVERE CANAL NARROWING SUSPECTED. NO SIGNIFICANT NEURAL FORAMINAL NARROWING. UNCHANGED 3 INTRA-ARTICULAR CAGE DEVICES OF THE RIGHT SACROILIAC JOINT AND LEFT TOTAL HIP ARTHROPLASTY. DEPENDENT ATELECTASIS SEEN IN THE RIGHT LUNG BASE. DIFFUSE BRONCHIAL WALL THICKENING WHICH MAY BE SEEN WITH AIRWAY DISEASE OR BRONCHITIS. BILATERAL ATHEROSCLEROTIC OSSIFICATION OF THE ABDOMINAL AORTA AND BRANCH VESSELS WITHOUT ANEURYSMAL DILATATION. DIVERTICULA ARE NOTED THROUGHOUT THE SIGMOID COLON. NO EVIDENCE FOR DIVERTICULITIS. IMPRESSION: INTERBODY SPACING DEVICE APPEARS DISPLACED POSTERIORLY AND LATERALLY INTO THE RIGHT LATERAL RECESS. NO FRACTURES. GRADE 1 ANTEROLISTHESIS OF L4 AND L5 STATUS POST PLIF. THE REMAINING HARDWARE APPEARS INTACT. MULTILEVEL DEGENERATIVE DISC DISEASE AND FACET ARTHROSIS. AT THE TIME OF DICTATION, THE PATIENT'S RECORD IN CERNER WAS REVIEWED AND THE HARDWARE MALFUNCTION WAS CORRECTED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1501517 | ADAPTIX¿ INTERBODY SYSTEM WITH TITAN NANOLOCK¿ SURFACE TECHNOLOGY | INTERVERTEBRAL FUSION DEVICE WITH BONE GRAFT, | MAX | TITAN SPINE, INC. | 84332812 | TM0128915 | 00763000203023 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 76 YR | Female | Required Intervention |